Why do elderly diabetics burden the health care system more than non-diabetics?

Visits to general practitioners and outpatient clinics were studied among 228 known diabetics and 223 sex and age matched non-diabetic controls. Of the diabetics, 52 were treated with insulin (32 NIDDM, 20 IDDM), 101 with diet plus oral hypoglycaemic agents, and 66 with diet only. Nine were untreated. Information on visits to general practitioners and outpatient clinics during the 12 months preceding ascertainment was obtained from local and national registers. The association between number of visits, subjective symptoms and type of antidiabetic treatment was analysed. The diabetics had a higher score for subjective symptoms and a higher frequency of objective findings than controls. After controlling for these differences, the diabetics in all antidiabetic treatment groups still had a higher number of visits than non-diabetics. Insulin treated diabetics, IDDM or NIDDM, had twice as many visits to physicians due to outpatient clinic visits than the other treatment groups. The costs of treating elderly diabetics may be reduced if these patients are treated more vigorously by diet and oral hypoglycaemic agents in general practice, thus avoiding time-consuming and costly insulin treatment for some of these patients.     

Predictors of short-term treatment response in 66 patients with panic disorder

Short-term treatment response in panic disorder was studies in 66 subjects who had completed 3 weeks of treatment with fluvoxamine (n = 23), cognitive therapy (n = 20), or placebo (n = 23). Clinical and self-rated assessments were gathered at baseline, during, and after treatment. Using multiple logistic regression, treatment with fluvoxamine, a low panic attack severity score, and absence of a comorbid personality disorder were identified as significant predictors of recovery. Personality disorder was an important negative predictor to outcome with cognitive therapy. The results support the efficacy of fluvoxamine, and show that patients with low symptom severity and a normal personality respond well to treatment.     

Glipizide does not affect absorption of glucose and xylose in diabetics without residual beta-cell function

We have previously demonstrated that oral glipizide suppresses the absorption of xylose in diabetics treated with diet alone. We suggested that glipizide might influence postprandial glucose levels by interfering with absorptive mechanisms. In the present study we have extended our observations to insulin-dependent diabetics (IDDM). Nine non-obese diabetics without residual beta-cell function and with normal respiratory sinus arrhythmia and Valsalva ratio were studied on two occasions. Their ordinary insulin treatment was discontinued 24 hours before the study and glucose control was maintained by i.v. insulin infusion. The experiments began at 8 a.m. after an overnight fast. Insulin was given as a continuous i.v. infusion of 0.01 U/kg/h at 8-11 a.m. and 0.005 U/kg/h at 11 a.m. -2 p.m. At 8 a.m. the patients ingested 25 g of xylose and 15 g of glucose in 300 ml of water. Glipizide (5 mg) or placebo were given 30 min prior to the glucose-xylose load in random order, each patient serving as his own control. Blood samples were taken every 60 min for analysis of glucose, xylose, C-peptide and glipizide. The rise in blood glucose in the control experiment was similar to that previously seen in non-insulin-dependent diabetics (NIDDM) given the same xylose-glucose load. Glipizide did not exert any effects on either blood C-peptide, glucose or xylose levels. We conclude that oral glipizide administered in a therapeutic dose does not reduce xylose absorption in IDDM, in contrast to its previously demonstrated effect in NIDDM.     

Memory activation in healthy nonagenarians

Little is known about brain function in the oldest old, although this is the fastest growing segment of the population in developed countries and is of paramount importance in public health considerations. In this study, we investigated the cerebral response to a memory task in healthy subjects over age 90 compared with healthy younger elderly.We studied 29 healthy elderly subjects, 12 over age 90 and 17 between age 70 and 80. All subjects were cognitively intact, as verified by a neuropsychological battery, and performed a nonverbal memory task while undergoing a functional MRI (fMRI). Activation results were analyzed by a random-effects ANCOVA using SPM5. The task resulted in activation of similar areas of the posterior temporal, parietal, and posterior frontal cortexes, but the activation was more robust in the younger subjects, especially in the right hippocampus, and parietal and temporal cortices. This finding remained after controlling for education, cognition, task performance or cerebral atrophy.The phenomenon of relatively maintained performance, despite significant brain atrophy and lower activation is consistent with the cognitive reserve theory and may be specific to subjects with extremely successful aging. Further investigation of brain activation patterns in the oldest old is warranted.     

Alleles of the IL12B 3'UTR associate with late onset of type 1 diabetes

Carriage of a polymorphism in the 3′untranslated region of the IL12B gene encoding IL-12p40 was investigated in subjects with type 1 diabetes mellitus stratified by age at diagnosis (n = 648) and compared with a population-based control cohort (n = 246) residing in Western Australia. DNA samples were genotyped by polymerase chain reaction-restriction fragment length polymorphism or pyrosequencing. The C allele was more common in patients diagnosed after age 16 years than in controls (29% vs 17%, OR = 2.0, 95% CI = 1.4–2.7, p = 0.00003) or than in patients diagnosed when younger age 16 years (29% vs 22%, OR = 1.4, 95% CI = 1.1–1.9, p = 0.01). This reflected increases in homozygous and heterozygous carriage of the C allele. Heterozygosity was associated with a delayed disease in the late-onset diabetics (p = 0.005; Student’s t-test). The effects of IL12B 3′untranslated region alleles on type 1 diabetes mellitus may reflect different levels of p40 available to form p40 homodimer, IL-12 (p35p40), and IL-23 (p19p40).     

A general anxiety-prone cognitive style in anxiety disorders

Objective: This study compared scores on the Anxious Thoughts & Tendencies (AT&T) questionnaire, a putative measure of a general anxiety-prone cognitive style, among patients with panic disorder without agoraphobia (PD, n=62), panic disorder with agoraphobia (PDA, n=29), generalized anxiety disorder (GAD, n=43), limited social phobia (LSP, n=34), generalized social phobia (GSP, n=33), and community residents (n=319). Method: Candidates for treatment studies completed a diagnostic interview and the AT&T. AT&T scores were compared among anxious groups using analysis of variance. Then depressed and non-depressed patients were compared. The final analysis compared anxious groups without comorbid depressive or anxiety disorders. Results: AT&T scores were highest in PDA patients, followed by patients with GAD or GSP, then patients with PD or LSP, with community residents lowest. Depressed patients were higher than non-depressed patients. Patients with current or past comorbid depressive disorders did not differ. The ranking of anxious groups on AT&T scores remained unchanged after exclusion of patients with comorbid disorders. Patients with PD or LSP without comorbidity had the same AT&T levels as the community sample. Conclusions: The AT&T discriminates PDA and GAD from PD per our hypothesis. The low AT&T levels among patients with PD and LSP suggest no association with a general anxiety-prone cognitive style. LSP and GSP may be distinct disorders. The cognitive style assessed by the AT&T is also associated with depression and may be a marker for vulnerability to depression. Definitive conclusions about a pathogenic role for cognitions require their measurement before the onset of the disorder.     

A brain MRI study in subjects with borderline personality disorder

Background: There have been only a few brain computed tomography imaging studies, with mostly negative findings, in subjects with borderline personality disorder (BPD). This is the first MRI study which evaluated the structural abnormalities of the brain in subjects with the sole diagnosis of BPD. Methods: Twenty-five subjects with BPD were compared with age-, gender-matched healthy comparison subjects (n=25) on volumes of the frontal lobes, the temporal lobes, the lateral ventricles, and the cerebral hemispheres in brain magnetic resonance imaging. Results: Subjects with BPD had a significantly smaller frontal lobe compared to comparison subjects (multivariate regression analysis, t=2.225, df=46, P=0.031). There were no significant differences in volumes of the temporal lobes, the lateral ventricles, and the cerebral hemispheres between subjects with and without BPD. Limitations: Strict inclusion and exclusion criteria employed in the present study may make it difficult to generalize our findings. The gray matter and white matter of the brain were not measured separately. Differences in head tilt during image acquisition were not corrected. Conclusions: The current study reports a smaller frontal lobe volume on brain MRI in subjects with BPD compared with healthy comparison subjects. This finding may serve as a potentially useful biological variable that may allow for subtyping BPD.     

Glucose transport in human peripheral blood lymphocytes influenced by type 2 diabetes mellitus

Introduction: The objective of this study was to evaluate glucose transport into lymphocytes in healthy subjects and patients with type 2 diabetes mellitus (DM) treated either with diet only or with insulin and to propose peripheral blood lymphocytes as a convenient model for cellular glucose transport studies. Materials and Methods: Sixty subjects with type 2 DM, 30 treated with diet only and 30 with insulin, were investigated. Thirty healthy subjects matched for age, weight, and sex served as a control group. Deoxy-D-glucose, 2-[³H(G)] transport was studied in isolated peripheral blood lymphocytes. Expression of glucose transporters was ascertained by immunocytochemical identification and by Western blotting. Results: In lymphocytes from the control group, deoxy-D-glucose uptake increased gradually with the duration of the experiment. In diabetics treated with insulin, the maximal increase in deoxy-D-glucose uptake was observed after 30 min of the investigation, followed by a plateau phase. In diabetics treated with diet, deoxy-D-glucose uptake increased slowly during the first 30 min. The presence of GLUT1 and GLUT3 in lymphocytes was confirmed in this study. Conclusions: Glucose transport into lymphocytes is altered in type 2 DM. In lymphocytes from diabetics, the dynamics of deoxy-D-glucose uptake significantly differed from that in healthy subjects. There was also a significant difference between the diabetic groups, representing different modes of therapy and stages of the disease. Glucose transport into lymphocytes is apparently influenced by DM as well as by the mode of therapy. We suggest that peripheral blood lymphocytes may become a promising model for studies on glucose transport in diabetes.     

Fasting, postprandial and postprandial plus glucagon-stimulated plasma C-peptide levels in non-insulin-dependent diabetics and in control subjects

We have studied fasting, postprandial and postprandial plus glucagon-stimulated plasma C-peptide levels in 149 non-insulin-dependent diabetics treated either with diet or oral drugs and in 101 non-diabetic control subjects. Diet-treated diabetics showed the highest fasting, postprandial and post-glucagon C-peptide levels in both sexes. In men, diabetics treated with oral drugs showed lower postprandial and glucagon-stimulated C-peptide levels than control subjects, while in women C-peptide levels in this group of diabetics were similar to those in control subjects. The distribution of individual plasma C-peptide levels was wide in non-insulin-dependent diabetics and control subjects and there was considerable overlapping in plasma C-peptide distribution for diabetics and control subjects. Fasting and post-glucagon plasma C-peptide levels in diabetics showed an inverse association to plasma glucose levels and a positive association to degree of obesity, but no association with the known duration of diabetes.     

颈椎前路减压手术治疗单侧肌萎缩型颈椎病的疗效分析

目的 探讨颈椎前路减压手术治疗单侧肌萎缩型颈椎病患者的临床疗效。方法 回顾性分析2005年1月—2014年1月河北医科大学第三医院脊柱外科行颈椎前路减压手术治疗的35例肌萎缩型颈椎病患者临床资料,其中男24例、女11例,年龄35~70岁,病程1~36个月,术后随访12~36个月(平均23.2个月)。依据肌肉萎缩最严重部位,将患者分为近侧型组(23例)和远侧型组(12例)。采用徒手肌力试验方法评估患者术前、术后肌力等级。行X线摄片、CT及MRI检查,观察并比较患者神经受累节段、术前脊髓信号强度的改变、神经受侵犯部位及患者肌力改善程度和时间。结果 近侧型组C_4/5水平最常受累(39.1%,9/23),远侧型组为C_5/6水平(10/12)。14例患者术前MRI T₂WI发现脊髓内信号增强。侵犯腹侧神经根的患者有24例、侵犯脊髓前角的29例,其中两者均受侵犯18例。术后肌力增加1级及以上者近侧型组达82.6%(19/23),而远侧型只有5/12(P=0.022)。近侧型组术后15 d内肌力改善的患者达56.5%(13/23),而远侧型无一例改善(Z=-3.255, P<0.01)。结论 颈椎前路减压手术对肌萎缩型颈椎病疗效肯定,而远侧型肌萎缩组疗效较差且恢复较慢。     

Hippocampal and ventricular changes in Parkinson's disease mild cognitive impairment

We analyzed T1-weighted brain magnetic resonance imaging data of 100 cognitively normal elderly controls (NC), 127 cognitively normal Parkinson's disease (PD; PDCN) and 31 PD-associated mild cognitive impairment (PDMCI) subjects from the Norwegian ParkWest study. Using automated segmentation methods, followed by the radial distance technique and multiple linear regression we studied the effect of clinical diagnosis on hippocampal and ventricular radial distance while adjusting for age, education, and scanning site. PDCN subjects had significantly smaller bilateral hippocampal radial distance relative to NC. Nonamnestic PDMCI subjects showed smaller right hippocampal radial distance relative to NC. PDMCI subjects showed significant enlargement of all portions of the lateral ventricles relative to NC and significantly larger bilateral temporal and occipital and left frontal lateral ventricular expansion relative to PDCN subjects. Nonamnestic PDMCI subjects showed significant ventricular enlargement spanning all parts of the lateral ventricle while those with amnestic PDMCI showed changes localized to the left occipital horn. Hippocampal atrophy and lateral ventricular enlargement show promise as structural biomarkers for PD.     

Brain atrophy associated with baseline and longitudinal measures of cognition

The overall goal was to identify patterns of brain atrophy associated with cognitive impairment and future cognitive decline in non-demented elders. Seventy-one participants were studied with structural MRI and neuropsychological testing at baseline and 1-year follow-up. Deformation-based morphometry was used to examine the relationship between regional baseline brain tissue volume with baseline and longitudinal measures of delayed verbal memory, semantic memory, and executive function. Smaller right hippocampal and entorhinal cortex (ERC) volumes at baseline were associated with worse delayed verbal memory performance at baseline while smaller left ERC volume was associated with greater longitudinal decline. Smaller left superior temporal cortex at baseline was associated with worse semantic memory at baseline, while smaller left temporal white and gray matter volumes were associated with greater semantic memory decline. Increased CSF and smaller frontal lobe volumes were associated with impaired executive function at baseline and greater longitudinal executive decline. These findings suggest that baseline volumes of prefrontal and temporal regions may underlie continuing cognitive decline due to aging, pathology, or both in non-demented elderly individuals.     

Polymorphisms at the GLUT2 (β-cell/liver) glucose transporter gene and non-insulin-dependent diabetes mellitus (NIDDM): analysis in affected pedigree members

The precise genetic defects underlying the etiology of non-insulin-dependent diabetes mellitus (NIDDM) have yet to be identified. The beta-cell/liver glucose transporter gene GLUT2 represents a good candidate for the etiology of the disease, being involved in the glucose signalling for beta-cell insulin release. Population association studies of the GLUT2 gene in NIDDM have so far yielded controversial results. In order to determine the possible contribution of this gene to the inheritance of NIDDM, we have employed a new approach, where two polymorphic markers of the GLUT2 locus, detected with the restriction enzyme Taq-1, were examined for linkage with the disease in a group of 22 Italian pedigrees with affected members (n = 50). Departure from independent segregation between markers and disease was analyzed by the Affected-Pedigree-Members (APM) statistical method. Furthermore, association analysis between the Taq-1 RFLPs at the GLUT2 locus and NIDDM was performed in a group of diabetics with a strong family history, comprising the 22 probands and 23 other diabetics with an affected first-degree relative. The results indicate that there was no segregation distortion between the Taq-1 markers of the GLUT2 gene and the disease in the pedigrees examined. Also, no significant difference in genotype distribution, haplotype and allele frequencies was found between diabetics and controls for the two Taq-1 RFLPs. We conclude that genetic variation at the GLUT2 transporter gene is unlikely to contribute in a major way to the inheritance for NIDDM in this Italian population.     

Aging does not affect the sleep endocrine response to total sleep deprivation in humans

Aging is associated with decreased sleep continuity, slow wave sleep (SWS), growth hormone (GH) release and an increased hypothalamo-pituitary-adrenocortical (HPA) system activity. Total sleep deprivation (TSD) is a strong stimulus for sleep. To determine if aging affects the response to TSD, for the first time the combined effects of TSD on conventional and spectral sleep electroencephalographic (EEG) parameters and GH, cortisol and prolactin secretion were compared in elderly (60–80 years; n = 7) vs. younger subjects (20–30 years; n = 7). MANOVA revealed a reduction of SWS in the elderly. TSD led to an increase in SWS, a decrease in sleep onset latency, rapid eye movement (REM) density and by trend REM-latency without a global group difference. GH was reduced, whereas prolactin was enhanced in the elderly. After TSD GH was unchanged and prolactin secretion was enhanced without group difference. Thus, the plasticity of the sleep-endocrine system in response to TSD is sustained during aging. The possible involvement of the GABAergic system, that seems not to be severely impaired with age, is proposed.     

Volumetric correlates of memory and executive function in normal elderly, mild cognitive impairment and Alzheimer's disease

In Alzheimer's disease (AD), atrophy negatively impacts cognition while in healthy adults, inverse relationships between brain volume and cognition may occur. We investigated correlations between gray matter volume and cognition in elderly controls, AD and mild cognitive impairment (MCI) patients with memory and executive deficits. AD demonstrated substantial loss in temporal, parietal and frontal regions while MCI exhibited moderate volume loss in temporal and frontal regions. In controls, memory and executive function were negatively correlated with frontal regions, while in AD, memory was positively correlated with temporal and frontal gyri, and executive function with frontal regions. The combination of the two patterns may explain the lack of correlations in MCI. Developmental versus pathological contributions to these relationships are discussed.     

阿尔茨海默病的早期诊断--认知与定量磁共振指标的作用

目的：(1)探讨阿尔茨海默病(AD)患者认知特点及磁共振成像(MRI)内颞叶结构定量成像特点；(2)拟提出指导AD临床诊断与鉴别诊断的认知指标与MRI定量指标。方法：选取52名AD患者为研究对象，27名血管性痴呆患者(VD)和35例年龄匹配的健康人为对照。采用阿尔茨海默病评定量表-认知部分(ADAS-Cog)、韦氏记忆量表-修订版(WMS-R)和简短心理状况检查(MMSE)评估认知功能。采用定量MRI测量内颞叶结构体积。结果：(1)AD患者学习与记忆、理解、语言、注意力和定向力等方面的障碍比VD患者和正常老人显著。(2)AD患者的海马结构、杏仁核及海马旁回的萎缩比VD患者和正常老人明显。(3)词语回忆、定向力、逻辑记忆等认知指标区分AD、VD和正常老人的总体准确性为83．3％。左侧侧脑室颞角和杏仁核海马复合体体积区分三组被试的准确性为77．1％。联合认知指标和MRI指标，诊断准确性为90．5％。结论：AD具有特征性认知改变和内颞叶结构萎缩．认知指标和内颞叶MRI定量指标对AD的鉴别诊断具有一定提示性意义。     

Community care for elderly diabetics: the Fredericia Survey of diabetic and fasting hyperglycaemic subjects aged 60-74 years

A study was undertaken of the use of community care services by 228 known diabetics and 87 subjects with one fasting blood glucose greater than or equal to 7 mmol/l (fasting hyperglycaemics) found during population screening of a geographically well-defined population aged 60-74 years. The two groups were compared with non-diabetic control groups with the same sex and age distribution as the study groups. The group of known diabetics comprised 52 insulin treated, 101 treated with oral hypoglycaemic agents + diet, 66 diet treated, and nine untreated. Information on community care services (pensions, home help, home nursing care, sick benefit, rent allowance, and technical aids) during the 12 months before ascertainment was obtained from the municipality office. Fasting hyperglycaemics did not receive more community care services than controls other than with regard to home help. More known diabetics received community care services than non-diabetics. Insulin treated diabetics received disability pension, aids, and home nursing care more often than the non-insulin treated. The mean number of hours of home help per person per year was 3-4 times higher for known diabetics in all antidiabetic treatment groups than for controls. The mean number of visits by home nurses/person/year for insulin treated diabetics was 83, for the non-insulin treated 6-7, and for controls 1-2 visits. Insulin injections and treatment of ulcers were the main reasons for the visits.(ABSTRACT TRUNCATED AT 250 WORDS)     

Circulating immune complexes in patients with diabetes mellitus.

Circulating immune complexes (CIC) were detected by the solid phase C1q binding assay in 16% of 103 diabetic patients and by the fluid phase C1q binding assay in 31% of patients as compared to 5% of 58 control subjects for each assay. Plasma glucose determinations revealed that most patients were moderately hyperglycaemic (mean glucose = 264 mg/dl), and thus were not selected for tight metabolic control. All but six patients had elevated levels of plasma insulin, including both the insulin treated and diet treated subgroups. There was no correlation between the presence of CIC detected by either assay and plasma glucose, insulin, or the presence of microangiopathy. Multiple factors must contribute to the increase in CIC in both insulin deficient and insulin resistant diabetics. The role of these various factors remains to be defined.     

A double-blind, placebo-controlled study of the effects of lithium on cognition in healthy subjects: mild and selective effects on learning

Background: Several studies have shown cognitive impairment in short-term memory, long-term memory and psychomotor speed in bipolar patients taking lithium. The aim of the study was to look at the effect of lithium in normal subjects (N=30) taking lithium for 3 weeks. A comprehensive battery was used to assess attention and memory. Methods: Subjects were randomized to double-blind treatment with either lithium (N=15) or placebo (N=15) for a 3-week period. Thirteen participants in the lithium group and 15 in the placebo group completed the study. The lithium and placebo were administered twice daily in doses varying from 1050 to 1950 mg (mean=1569 mg). The initial daily dose was calculated according to the Pepin formula to achieve a blood serum lithium level of about 0.8 mmol/l. Cognitive performance (attention, memory) was assessed in each subjects during three periods, i.e. at baseline, after 3 weeks of lithium or placebo, and 2 weeks after discontinuation of study medication. Results: In short-term memory tasks, the performance of subjects in the lithium group was worst 3 weeks after lithium treatment compared to 2 weeks after discontinuation. In long-term memory, a significantly higher number of words was recalled by the placebo group but not the lithium group. Conclusions. Lithium may have an effect on learning when long-term explicit memory test are administered repeatedly. It means that the practice effect when a subject performs the same task several times is less in the lithium-treated group than in the placebo group. This practice effect is related to the learning of a task.     

Early effects of continuous low-dosage dl-norgestrel administered alone or with estrogen

Twenty-six postmenopausal women participated in a double-blind trial involving treatment according to a Latin square design with either (i) dl-norgestrel alone (0.075 mg/day) continuously for two cycles, (ii) estradiol-17β alone (1 mg on 25 of 28 days) for two cycles, or (iii) the combined hormones for six cycles. A placebo control cycle followed each hormonal treatment. Plasma triglycerides decreased by an average of 22% during treatment with either dl-norgestrel alone (123 ±11 vs. 160 ±10 mg/dl, n = 25, P < 0.005) or combination therapy (126 ±11 vs. 162 ±11, n = 25, P < 0.005) as compared with control. Plasma total cholesterol fell by 5% during two cycles of treatment with either dl-norgestrel alone (229 ±11 vs. 242 ±10 mg/dl, n = 25, P < 0.02) or combination therapy (233 ± 11 vs. 246 ±10, n = 25, P < 0.05) versus placebo. During the fifth and sixth cycles of combination therapy 94% of cycles were free of flushing (vs. 31% for control, P < 0.01), 64% of cycles were free of spotting not requiring protection (control 75%), 96% of cycles were free of vaginal bleeding (control 100%), endometrial biopsy showed inactive endometrium in nine of the 10 subjects re-biopsied, fasting blood pyruvate decreased by 20% (P < 0.05) and diastolic blood pressure fell by 4% compared with control (P < 0.05), whereas glucose tolerance was unchanged. There was a significant reduction in vasomotor flushing beginning with the third to fourth cycles of combination therapy.